| NPI | 1861499485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4412) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: AZ 4412) |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2023-03-08 |