| NPI | 1184615346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9807) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 15940) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2013-04-25 |