| NPI | 1730433400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OR 5047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5047) |
| 111NR0400X (Licence: OR 5047) | |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2020-01-24 |