| NPI | 1902968639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7781) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2006026659) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2018-08-06 |