| NPI | 1740289248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8537) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: ID chia-872) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2020-04-16 |