| NPI | 1831255033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 4975198-1202) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: UT 4975198-1201) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |