| NPI | 1578831327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8328) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ ATR-001261) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2019-08-01 |