| NPI | 1871605980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7517) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4209) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-12-13 |