| NPI | 1447296165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2533) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: SC 2533) |
| 111NR0400X (Licence: SC 2533) | |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: SC 2533) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: SC 2533) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-11-06 |