| NPI | 1083256663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 14172) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14172) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: TX 14172) | |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-15 |