| NPI | 1225455843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1634) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11411) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2022-02-28 |