| NPI | 1710132279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7949) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: AZ 4634) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2013-05-28 |