| NPI | 1700063757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10741) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 68563151202) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2015-01-18 |