| NPI | 1356445092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: TX 8225) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8225) |
| 111NS0005X Chiropractor, Sports Physician (Licence: TX 8225) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2008-06-26 |