| NPI | 1912322520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8372) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 8372) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2016-12-12 |