| NPI | 1043277106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: AZ 7301) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA DC28427) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2010-10-29 |