| NPI | 1629383989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7722740-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 7722740-1202) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2010-08-11 |