| NPI | 1043595242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11875) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1611) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2016-02-03 |