| NPI | 1164647996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8895) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 8895) |
| 111NR0400X (Licence: TX 8895) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 8895) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-05-02 |