| NPI | 1770748279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX TFL001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 1153) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2012-06-04 |