| NPI | 1669467841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ AZ4463) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4463) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2024-07-22 |