| NPI | 1255331286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 6633) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 01040000762) |
| 111N00000X Chiropractor (Licence: WV 508) | |
| 111N00000X Chiropractor (Licence: MD 1442PT) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2023-03-31 |