| NPI | 1427157486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 7960) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001807A) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-04-11 |