| NPI | 1114196219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2011039597) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11188) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2020-02-12 |