| NPI | 1891750311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ DC4997) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: AZ 2761) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2012-06-27 |