| NPI | 1316091069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 339) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5156) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-08-01 |