| NPI | 1386922862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 596) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6670) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2023-11-15 |