| NPI | 1497967012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10349) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10349) |
| 111NS0005X Chiropractor, Sports Physician (Licence: TX 10349) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2013-03-29 |