| NPI | 1669859914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 06865) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 06865) |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 06865) | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2015-05-06 |