| NPI | 1932255593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: MT 1048) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1048) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2020-03-09 |