| NPI | 1518054014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 16001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25795) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2024-05-16 |