| NPI | 1538479878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1874) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11359) |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2011-02-22 |