| NPI | 1174639686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA AO5225) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: IA AO5225) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2017-10-12 |