| NPI | 1336118934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: LA 269) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AL 767) |
| 111NS0005X Chiropractor, Sports Physician (Licence: FL 5601) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 2852) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |