| NPI | 1932449568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 4960) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8314) |
| Enumeration Date | 2013-02-19 |
| Last Update Date | 2013-05-14 |