| NPI | 1154404978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: WA 3291) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: ID 843) |
| 111NS0005X Chiropractor Sports Physician (Licence: MT 809) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-12-01 |