| NPI | 1356441075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10252) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3769) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2023-12-04 |