| NPI | 1619059730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 6133627-1202) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: UT 6133627-1202) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2024-08-28 |