| NPI | 1881623064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ AZ4859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A05548) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2012-07-05 |