| NPI | 1720128721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5103) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: TX 5103) |
| 111NR0200X Chiropractor, Radiology (Licence: TX 5103) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: TX 5103) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 5103) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: TX 5103) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |