| NPI | 1568521383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC23957) |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2012-06-26 |