| NPI | 1336226539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 7080) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: TX 7080) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |