| NPI | 1104150960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9000437-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11172) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2015-05-07 |