NPI | 1851693873 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 11599) |
Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 11599) |
111NN1001X Chiropractor, Nutrition (Licence: TX 11599) | |
Enumeration Date | 2010-11-23 |
Last Update Date | 2018-11-07 |