| NPI | 1306959440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8488) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00381) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |