| NPI | 1295867935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00517) |
| Additional Taxonomies | 111NR0400X (Licence: NV B00517) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NV B00517) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |