| NPI | 1114551306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15517) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6692) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2025-05-19 |