| NPI | 1285769935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10371) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6103) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2011-10-03 |