| NPI | 1376614719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11659) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28662) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2014-08-23 |