| NPI | 1457537862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: ID CHIA-1284) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1284) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2008-09-03 |