| NPI | 1235383852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10928) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: TX 10928) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2009-11-18 |