| NPI | 1629018643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 5611) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5611) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-08-10 |