| NPI | 1316259088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11496) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2018-06-27 |