| NPI | 1144741075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 13142) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13142) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2018-03-17 |