| NPI | 1174525687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6761) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 6761) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2010-05-12 |