| NPI | 1457508517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OH 4036) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008368) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2015-08-21 |