| NPI | 1194724989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AL 1059) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AL 1059) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2019-09-04 |