| NPI | 1497970602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MD 1898PT) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA dc009254) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2012-10-10 |