| NPI | 1750354171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 30945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA AJ008986) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: CA 30945) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: PA DC009162) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-03-17 |