| NPI | 1467752923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8280) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7795024-1202) |
| Enumeration Date | 2010-10-29 |
| Last Update Date | 2014-10-23 |