| NPI | 1487815379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MA 3397) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104556681) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2014-06-19 |