| NPI | 1508932765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 98494) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5398) |
| 111N00000X Chiropractor (Licence: NM 1990) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-09-11 |