| NPI | 1750422374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHAI-1226) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10034) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |