| NPI | 1639219785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: TX 9958) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX 9958) |
| 111NR0400X (Licence: TX 9958) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: TX 9958) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: TX 9958) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-09 |