| NPI | 1639155161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4461) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 60) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2012-04-30 |