| NPI | 1447302146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1449) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NE 430) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 00599) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |