| NPI | 1619954005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NC NC2475) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: SC SC2487) |
| 171100000X Acupuncturist (Licence: 3852) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2013-01-09 |