| NPI | 1851300115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9744) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10073) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2014-05-14 |