| NPI | 1922211135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 6855) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6855) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CO 1072) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-06-02 |