| NPI | 1699274357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9016) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34098) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2021-08-18 |