NPI | 1104035690 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10465) |
Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: TX 10465) |
111NS0005X Chiropractor, Sports Physician (Licence: TX 10465) | |
Enumeration Date | 2007-05-21 |
Last Update Date | 2007-12-17 |