| NPI | 1366589764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13259) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1849) |
| 111N00000X Chiropractor (Licence: OH 4101) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2022-10-03 |