| NPI | 1831257500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: UT 500911-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: TX DC8402) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-10-17 |