| NPI | 1326039710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TX 10117) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10117) |
| 111NN1001X Chiropractor Nutrition (Licence: TX 10117) | |
| 111NX0800X Chiropractor Orthopedic (Licence: TX 10117) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2009-01-27 |