| NPI | 1003930967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: ID CHIA-1306) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OH 1586) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2009-02-04 |