| NPI | 1508089855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6078) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX 6078) |
| 111NR0400X (Licence: TX 6078) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-09 |