| NPI | 1487778023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7419) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 449) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2024-04-23 |