| NPI | 1578377636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 16351) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 16351) |
| Enumeration Date | 2025-02-06 |
| Last Update Date | 2025-02-06 |