| NPI | 1164760443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12222) |
| Additional Taxonomies | 111NT0100X Chiropractor, Thermography (Licence: TX 12222) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2013-01-22 |