| NPI | 1790871523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5212) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 2937) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2012-07-19 |