| NPI | 1811218100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8087) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 4742) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-06-21 |