| NPI | 1841487436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7860) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4552) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2014-04-21 |