| NPI | 1043819303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 12405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14514) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2024-09-24 |