| NPI | 1417481342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13966) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0129172) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-05-25 |