| NPI | 1700870698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC4588) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 26657) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2007-07-08 |