| NPI | 1508240839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1736) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2017-09-21 |