| NPI | 1396064507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11470) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1100625) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2024-04-04 |