| NPI | 1306049697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8003) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 8003) |
| 111NR0400X (Licence: TX 8003) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2007-07-08 |