| NPI | 1467482026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: SC 3145) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: SC 3145) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 770) | |
| 111N00000X Chiropractor (Licence: SC 3145) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-08-08 |