| NPI | 1548626088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0007584) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR009623) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2018-03-17 |