| NPI | 1396841664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10581) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR5938) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2019-07-30 |