| NPI | 1427558717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009946) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2022-10-31 |