| NPI | 1336239193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 15718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009674) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-04-01 |