| 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 |