| NPI | 1306872478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1011) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8245) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2021-04-09 |