| NPI | 1154753739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AL 2415) |
| Additional Taxonomies | 111NR0400X (Licence: AL 2415) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2014-01-09 |