NPI | 1811432768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NR0400X (Licence: TX 40510214) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 40510214) |
Enumeration Date | 2017-01-02 |
Last Update Date | 2022-07-21 |