| NPI | 1598700551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 3033DC) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131375) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2018-02-22 |