| NPI | 1508974007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9657) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9657DC) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2013-03-13 |