NPI | 1518233303 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12040) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 12040) |
Enumeration Date | 2012-03-27 |
Last Update Date | 2017-04-06 |