| NPI | 1811966013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5803) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 24849) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-11-09 |