| NPI | 1487045977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12895) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33134) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2015-03-16 |