| NPI | 1720116213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5555) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: TX 5555) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2010-12-03 |