| NPI | 1154597375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15490) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1132) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2023-11-07 |