| NPI | 1336462878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 4635) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO 4635) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2013-04-10 |