| NPI | 1376614453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OR 71-3327) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: OR 71-3327) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2008-05-08 |