| NPI | 1396961918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: TX 10520) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 10520) |
| 111NX0800X Chiropractor, Orthopedic (Licence: TX 10520) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-10-13 |