| NPI | 1578582276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC4239TX) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX DC4239TX) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-09 |