| NPI | 1255633723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11631) |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2012-03-23 |