| NPI | 1467512707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC6706) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6706) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2011-04-12 |