| NPI | 1649237132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX TX4299) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4299) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2010-09-17 |