| NPI | 1942268040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 26128) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2007-07-08 |