| NPI | 1528137635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 364161-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5313) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2011-07-25 |