| NPI | 1902011075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5834) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 21867) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2013-10-03 |