| NPI | 1851480362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 335178-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: UT 335178-1202) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-08-21 |