| NPI | 1386928786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12226) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 934) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2013-04-01 |