| NPI | 1205109733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11742) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01619) |
| Enumeration Date | 2012-02-14 |
| Last Update Date | 2018-03-30 |