| NPI | 1801000179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1501) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 111N00000X Chiropractor (Licence: TX 10851) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2010-06-03 |