| NPI | 1225456114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0007310) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11155) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY X012555-1) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2019-11-20 |