| NPI | 1376529388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 980) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: SD 980) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2012-09-06 |