| NPI | 1205224243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15533) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6007) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2023-08-15 |