| NPI | 1285694521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 04746) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: IA 124) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IA 3036) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: IA 2388) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2010-02-03 |