| NPI | 1538334909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11118) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00746) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2015-10-29 |