| NPI | 1154706265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 078973) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IA 078973) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-09-01 |