| NPI | 1093064255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007599) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12118) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2013-04-05 |