| NPI | 1205938560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11476) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5817) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2011-11-17 |