| NPI | 1790022382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8536046-1202) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: UT 8536046-1202) |
| 111NS0005X Chiropractor, Sports Physician (Licence: UT 8536046-1202) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: UT 8536046-1202) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2018-01-23 |