| NPI | 1558425306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7968) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 5157401-1202) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2012-10-18 |