| NPI | 1891082236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8259) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01426) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2014-11-24 |