| NPI | 1346575198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007212) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11191) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2019-01-08 |