| NPI | 1366484008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 3092) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: TX 3092) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2012-11-15 |