| NPI | 1316194194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 10944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10944) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2015-05-18 |