| NPI | 1114017290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4858) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: AZ 4858) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2010-02-01 |