| NPI | 1205920774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TX 6458) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: NC 2219) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |