| NPI | 1205095759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 6643) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: TX 06643) |
| 111N00000X Chiropractor (Licence: TX 6643) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2009-01-07 |