| NPI | 1619428166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 15520) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 114814) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OK 4351) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2025-01-07 |