| 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 |