| NPI | 1609974856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6634) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 0108948) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-05-02 |