| NPI | 1104914167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 0006936) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06918) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2016-06-06 |