| NPI | 1245323161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556445) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-09-02 |