| NPI | 1467455246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IN 08002643A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29075) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2014-12-02 |