| NPI | 1083750400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1364) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1082) |
| 111NS0005X Chiropractor, Sports Physician (Licence: LA 1364) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |