| NPI | 1124056882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: KY 5209) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR006531) |
| 111N00000X Chiropractor (Licence: NJ 38MC00653800) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-08-12 |