| NPI | 1730189903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 4238) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00179) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2013-03-21 |