| NPI | 1003259722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14072) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4366) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2019-09-26 |