| NPI | 1306022397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: FL CH 9799) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6185) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 060402688) | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2012-10-25 |