| NPI | 1912215302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1412) |
| 111N00000X Chiropractor (Licence: WY 738) | |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2013-09-11 |