| NPI | 1881650430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6013) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002267A) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2009-07-24 |