| NPI | 1558871491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15406) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: NC LAT-2533) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2024-07-24 |