| NPI | 1689673170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC2593) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX DC2593) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2014-11-03 |