| NPI | 1760474878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1173060) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5841) |
| 133N00000X Nutritionist (Licence: TX 5841) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2013-09-16 |