| NPI | 1275965204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10689) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 10689) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2013-08-01 |