| NPI | 1487145934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9341) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 108041421202) |
| 171100000X Acupuncturist (Licence: AZ 0631) | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2024-10-08 |