| NPI | 1104059104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 15157) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3956) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 3956) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2022-07-25 |