| NPI | 1275771685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11671) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9553) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2019-11-20 |