| NPI | 1538360888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7867) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 0559) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-01-11 |