| NPI | 1649284969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: TX 7918) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: NM 1594) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2014-12-17 |