| NPI | 1710041033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX D.C. 2832) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: TX D.C.2832) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2010-07-12 |