| NPI | 1851710412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 968) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: ND 968) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2014-04-10 |