| NPI | 1558445031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX TX4423) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001063) |
| 111N00000X Chiropractor (Licence: TN DC542) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |