| NPI | 1548656127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CO CHR.0008081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60547174) |
| 111N00000X Chiropractor (Licence: AZ 8540) | |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2021-10-23 |