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 |