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 |