| NPI | 1588850143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10605) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2003003359) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2007-09-18 |