| NPI | 1295947661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8137) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: TX 8137) |
| 111NN1001X Chiropractor Nutrition (Licence: TX 8137) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: TX 8137) | |
| 111NS0005X Chiropractor Sports Physician (Licence: TX 8137) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2007-07-08 |