| NPI | 1245787787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 7522) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12696) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2018-11-12 |