| NPI | 1750559043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22341) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2015-10-15 |