| NPI | 1306956719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1047) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5792) |
| 111N00000X Chiropractor (Licence: MS 761) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |