| NPI | 1669555983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11894) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4198-012) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-04-23 |