| NPI | 1891866075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8040) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19914) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2017-09-22 |