| NPI | 1477809820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32335) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2024-10-31 |