| NPI | 1659723989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1739) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: ID CHIN-1718) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-09-28 |