NPI | 1659473643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 3325R) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 3809) |
Enumeration Date | 2006-09-01 |
Last Update Date | 2021-12-15 |