| NPI | 1669427233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7143) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3034) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2009-07-23 |