| NPI | 1821199126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9995) |
| Additional Taxonomies | 111NR0400X (Licence: TX 9995) |
| 111NS0005X Chiropractor, Sports Physician (Licence: TX 9995) | |
| 111NN1001X Chiropractor, Nutrition (Licence: TX 9995) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-07-03 |