| NPI | 1528408283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8310) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 582) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-10-29 |