| NPI | 1740276294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7217) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AZ 2812) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2017-10-25 |