| NPI | 1114245131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NV 5801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01360) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2022-07-21 |