| NPI | 1992020630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11419) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2012-03-21 |