| NPI | 1821077694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IA 04452) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: IA 04452) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-08 |