| NPI | 1922001288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC6112) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX DC6112) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2010-04-30 |