| NPI | 1689964223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11612) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: TX AT4786) |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2013-06-05 |