| NPI | 1225246994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: TX 10431) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX 10431) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2013-08-14 |