| NPI | 1477828408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12479) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32222) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2022-03-08 |