| NPI | 1407097173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 9740) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX 9740) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2009-03-10 |