| NPI | 1164052825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14470) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008161) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2021-07-30 |