| NPI | 1558430793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 4245) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX 4245) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-10-09 |