| NPI | 1487843389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30685) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2009-05-29 |