| NPI | 1780793570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5142) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 2877) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |