| NPI | 1114101623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10422) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10422) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2020-11-11 |