| NPI | 1063795029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4971) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11676) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2023-08-23 |