| NPI | 1225149263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6134) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC9503) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-03-06 |