| NPI | 1689774242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7870) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2008-09-08 |