| NPI | 1548389166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 9868) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: TX 9868) |
| 111NN0400X Chiropractor Neurology (Licence: TX 9868) | |
| 111NX0100X Chiropractor Occupational Health (Licence: TX 9868) | |
| 111NN1001X Chiropractor Nutrition (Licence: TX 9868) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2013-08-13 |