| NPI | 1356422828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 262577-1202) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: UT 262577-1202) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-06-28 |