| NPI | 1336290998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7928) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2023-02-24 |