| NPI | 1316251762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 11498) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1839) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2022-01-20 |