| NPI | 1982767349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6023) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 3661) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2009-04-27 |