| NPI | 1598717522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10485) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10485) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-03-03 |