| NPI | 1316979776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11580) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0104441) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-06-04 |