| NPI | 1265554018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: ME CR695) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 4474) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 2837) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |