| NPI | 1649410267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1496) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10980) |
| Enumeration Date | 2009-02-22 |
| Last Update Date | 2009-05-21 |