| NPI | 1922347137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 8481185-1202) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 8481185-4810) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2013-02-07 |