| NPI | 1871863639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ dc5353) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 424) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2012-01-10 |