| NPI | 1043473044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00957) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NV NVMT 3166) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NV 0506436) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2017-04-24 |