| NPI | 1922144005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5955) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 3555) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2012-04-30 |