| NPI | 1003821778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8482) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX 8482) |
| 111NX0800X Chiropractor Orthopedic (Licence: TX 8482) | |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: TX 8482) | |
| 111NR0200X Chiropractor Radiology (Licence: TX 8482) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: TX 8482) | |
| 111NS0005X Chiropractor Sports Physician (Licence: TX 8482) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2008-12-12 |