| NPI | 1760547681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 6895) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: FL Ch 7955) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2008-06-25 |