| NPI | 1477627214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 6142) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC 22588) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-06-04 |