| NPI | 1467579672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10556) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY XO5928) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2023-11-10 |