| NPI | 1588873624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8056) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 006775) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-05-20 |