| NPI | 1457486359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5870) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 5870) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-03-02 |