| NPI | 1477070357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13566) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: TX 13566) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2018-03-17 |