| NPI | 1386653087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5194) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2323) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-03-12 |