| NPI | 1801106240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12027) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000002415) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2015-06-15 |