| NPI | 1427100213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3585) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 3995) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 3585) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: SD 3995) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2024-08-06 |