| NPI | 1467535286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7290) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 7290) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2009-07-10 |