| NPI | 1770704157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 364214-1202) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: UT 364214-1202) |
| 111NR0400X (Licence: UT 364214-1202) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: UT 364214-1202) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-07-08 |