| NPI | 1922246917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 4039) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4039) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2011-06-27 |