| NPI | 1134136914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor Occupational Health (Licence: TX DC4497) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TX DC4497) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |