| NPI | 1528518156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4693) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13310) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2022-01-26 |