| NPI | 1972576205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06535) |
| 111N00000X Chiropractor (Licence: UT 6252605-1201) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2017-04-25 |