| NPI | 1598759565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4991) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010908) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-07-08 |