| NPI | 1134455918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11301) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 11301) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2010-03-29 |