| NPI | 1407939051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5991) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-010686) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WA CH00034686) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2010-11-05 |