| NPI | 1033468582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1777) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 508) |
| 111N00000X Chiropractor (Licence: TX 12548) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2020-02-10 |