| NPI | 1972521649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8663) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3038) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-02-28 |