| NPI | 1003018680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00521600) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 38MC00521600) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY 38MC00521600) | |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 38MC00521600) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2016-12-21 |