| NPI | 1871528752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 4029) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT035182) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |