| NPI | 1578794913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 6390) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 30673) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2011-11-27 |