| NPI | 1689692709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4405) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 124) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-04-21 |