| NPI | 1467625681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11256) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038011146) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2012-03-13 |