| NPI | 1689781809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: MD 01964) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: MD 01964) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2009-05-07 |