| NPI | 1548220841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: AZ 7757) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06728) |
| 111N00000X Chiropractor (Licence: NY 11048) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-01-06 |