| NPI | 1154335552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11483) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1384) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2017-04-18 |