| NPI | 1649328170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 358787-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 3948) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-08-20 |