| NPI | 1629219365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TN 2611) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: TX 8781) |
| Enumeration Date | 2009-03-10 |
| Last Update Date | 2013-09-12 |