| NPI | 1568526556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 3030) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5338) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |