| NPI | 1659439131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MD S01689) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: VA 0104001116) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2023-02-24 |