| NPI | 1093237158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13543) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009878) |
| Enumeration Date | 2017-07-11 |
| Last Update Date | 2025-01-15 |