| NPI | 1215077516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID chia1233) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10922) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2012-12-11 |