| NPI | 1891832713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 2413) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: TX 2413) |
| 111NS0005X Chiropractor Sports Physician (Licence: TX 2413) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2011-10-17 |