| NPI | 1205907805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX DC5807) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM DC2182) |
| 163W00000X Registered Nurse (Licence: FL RN9617241) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-09-14 |