| NPI | 1114110897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2584) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2012-03-06 |