| NPI | 1205997657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14199) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007569) |
| 111N00000X Chiropractor (Licence: VA 0104557449) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-09-09 |