| NPI | 1467784181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7545378-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 7545378-1202) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2017-06-22 |