| NPI | 1417086760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IA A06120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA A06120) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2009-03-26 |