| NPI | 1639383607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5208) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B-570) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2026-04-10 |