| NPI | 1477971711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8350) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: AZ 8350) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2020-06-03 |