| NPI | 1952728545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor Neurology (Licence: TX 12535) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX 12535) |
| 111NS0005X Chiropractor Sports Physician (Licence: TX 12535) | |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2014-03-21 |