| NPI | 1194813675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: TX 6272) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1181) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2009-08-31 |