| NPI | 1013056456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011304-1) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2012-09-25 |