| NPI | 1447259312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 7964) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX 7964) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-10-22 |