| NPI | 1598828709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 15725) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4273) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-08-28 |