| NPI | 1851797179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8503) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9200562-1202) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2017-11-03 |