| NPI | 1043421969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 12433) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8557) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-07-02 |