| NPI | 1902888456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IA a06193) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4623) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2025-02-13 |