| NPI | 1043544240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11684) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31389) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2012-03-09 |