| NPI | 1275577322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 2319) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC2319) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2021-12-21 |