| NPI | 1629137369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NC 1935) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AL 1182) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MI 006532) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |