| NPI | 1639442163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2095) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AL 040202011) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2012-02-14 |