| NPI | 1073739678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 02810) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC17722) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2012-06-03 |