| NPI | 1013162791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CO 6306) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6306) |
| 111NN1001X Chiropractor Nutrition (Licence: CO 6306) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: CO 6306) | |
| 111NX0100X Chiropractor Occupational Health (Licence: CO 6306) | |
| Enumeration Date | 2008-11-23 |
| Last Update Date | 2024-04-27 |