| NPI | 1629232160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12605) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011263) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2014-09-29 |