| NPI | 1609198837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: CO 5115) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO 5115) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2010-02-15 |