| NPI | 1215038641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6137) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 2102) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |