| NPI | 1124464003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5696) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OR 5696) |
| 111N00000X Chiropractor (Licence: CO 0006947) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2016-12-13 |