| NPI | 1639534274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor Occupational Health (Licence: TX 09312) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 09312) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: TX 09312) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: TX 09312) | |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2015-12-28 |