| NPI | 1386738409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5736) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-08-22 |