| NPI | 1649448077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NC 3294) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NC 3294) |
| 111NN0400X Chiropractor, Neurology (Licence: NC 3294) | |
| 111NN1001X Chiropractor, Nutrition (Licence: NC 3294) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |