| NPI | 1104939271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1108) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: LA 4158) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2009-05-07 |