| NPI | 1730378654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8329) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: TX 8329) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2014-05-28 |