NPI | 1518073022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: TX DC4635) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC4635) |
171100000X Acupuncturist (Licence: TX DC4635) | |
Enumeration Date | 2006-08-21 |
Last Update Date | 2025-09-11 |