| NPI | 1831104504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10656) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1584) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2007-07-24 |