| NPI | 1689671315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5912) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1894) |
| 111N00000X Chiropractor (Licence: MT 928) | |
| 111N00000X Chiropractor (Licence: OK 2622) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-04-01 |