| NPI | 1811917172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 9289) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 111NS0005X Chiropractor, Sports Physician (Licence: UT 5118449-1202) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2014-10-30 |