| NPI | 1386637502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 6672) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9161) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2013-06-18 |