| NPI | 1457482689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4073) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: GA 2965) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2016-05-16 |