| NPI | 1083962237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 36726) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12116) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2023-10-24 |