| NPI | 1144462938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 6455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31214) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2010-02-12 |