| NPI | 1639321185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1190) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11004) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2010-03-01 |