| NPI | 1871628768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7618) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29283) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-04-19 |