| NPI | 1730248097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 363994-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ AZ7697) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2021-10-07 |