| NPI | 1396777363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1151) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5501) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-05-21 |