| NPI | 1316271729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 5576) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1210) |
| 111N00000X Chiropractor (Licence: TX 12431) | |
| Enumeration Date | 2009-10-01 |
| Last Update Date | 2020-03-04 |