| NPI | 1477807923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12420) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007600) |
| Enumeration Date | 2012-11-06 |
| Last Update Date | 2014-08-27 |