| NPI | 1124132337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX Tx 10427) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 3789) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-12-27 |