| NPI | 1114466224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10258334-1202) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: UT 10258334-1202) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2021-04-30 |