| NPI | 1306900188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: ID Chia-2028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID Chia-2028) |
| 111N00000X Chiropractor (Licence: CA DC29513) | |
| 111N00000X Chiropractor (Licence: HI DC531) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA DC29513) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2022-03-03 |