| NPI | 1386920353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11820) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 10406) |
| Enumeration Date | 2011-10-22 |
| Last Update Date | 2019-05-07 |