| NPI | 1730104209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 14210503-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 14210503-1202) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2026-09-01 |