| NPI | 1104833714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 6092) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6092) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-11-09 |