| NPI | 1982843298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007143) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IA 007143) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2022-07-21 |