| NPI | 1629071030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22143) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-12-27 |