| NPI | 1376813683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007607) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: IA 007607) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2023-09-01 |