| NPI | 1124162276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10532) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10532) |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 10532) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2025-01-10 |