| NPI | 1649237801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 9421) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: TX 9421) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2013-04-01 |