| NPI | 1265536593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 4094) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2409) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2007-08-23 |