| NPI | 1356696462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor Internist (Licence: TX 12056) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: TX 12056) |
| 111NN1001X Chiropractor Nutrition (Licence: TX 12056) | |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2012-07-16 |