| NPI | 1861596025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5058) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX 4624) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2015-01-26 |