| NPI | 1801996020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5291) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 5291) |
| 111NN1001X Chiropractor, Nutrition (Licence: TX 5291) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: TX 5291) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 5291) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: TX 5291) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2024-05-10 |