| NPI | 1336192087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12753) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038006969) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2019-10-03 |