| NPI | 1821068776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8830) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1237) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2008-03-31 |