| NPI | 1699936476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1728) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2011-02-15 |