| NPI | 1841475209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7938) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3790) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2008-05-19 |