| NPI | 1700114006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA chir008533) |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2012-04-17 |