| NPI | 1447349782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1681) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9946) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-04-20 |