| NPI | 1295811735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NH 270A) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MA 100) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |