| NPI | 1407223852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AK 125484) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012864) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2021-05-07 |