| NPI | 1316176514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 156609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05269) |
| 111N00000X Chiropractor (Licence: OK 4129) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2021-05-03 |