| NPI | 1205977030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 1358) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CO 1358) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |