| NPI | 1366509168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: IA 4045) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 174276-1202) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2023-04-05 |