| NPI | 1043534357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31583) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2022-05-23 |