| NPI | 1366766313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007278) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: IA 007278) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IA 007278) | |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2018-04-09 |