| NPI | 1154482537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1037) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: SC 1037) |
| 111NX0800X Chiropractor, Orthopedic (Licence: SC 1037) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |