| NPI | 1295813723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6237) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1325) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-11-03 |