| NPI | 1508369174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8486) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 5102) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2018-11-14 |