| NPI | 1619046166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 25448) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-11-18 |