| NPI | 1356734149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: TX 6436) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: TX 6436) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2015-03-18 |