| NPI | 1184027583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0007511) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12122) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2022-07-21 |