| NPI | 1104937028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 2943) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 483) |
| 111N00000X Chiropractor (Licence: OK 2312) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-07-21 |