| NPI | 1497731616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WI 3568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3568) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2025-09-11 |