| NPI | 1720155526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC6997) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 6997) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2016-11-28 |