| NPI | 1154569960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX S7093) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7130076-1202) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2023-07-05 |