| NPI | 1487786026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: OR 713668) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 713668) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2017-11-15 |