| NPI | 1932430782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: TX 11341) |
| Additional Taxonomies | 111NR0400X (Licence: TX 11341) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2022-02-23 |