| NPI | 1073841110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12072) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008534) |
| 111N00000X Chiropractor (Licence: MS 1169) | |
| Enumeration Date | 2009-12-01 |
| Last Update Date | 2017-03-28 |