| NPI | 1669536363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11271) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011291) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2011-01-18 |