| NPI | 1508816893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5943) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5843) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-03-28 |