| NPI | 1821282690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 6027) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AZ 6027) |
| 111NN1001X Chiropractor, Nutrition (Licence: AZ 6027) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2007-09-05 |