| NPI | 1306998109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3377) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12417) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2013-08-09 |