| NPI | 1003217449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 9123542-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9123542-1202) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2020-10-01 |