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 |