| NPI | 1023170479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CO 1963) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: ID CHIA-700) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-04-10 |