| NPI | 1417987132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00749) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8169) |
| 111N00000X Chiropractor (Licence: WI 5168-12) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2017-05-09 |