| NPI | 1417477688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01649) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NV B01649) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2021-04-24 |