| NPI | 1700921905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC 6385) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT016991) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |