| NPI | 1518092360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7699) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 4391) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-02-01 |