| NPI | 1538562475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: TX 12983) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO CHR0007185) |
| 111N00000X Chiropractor (Licence: CO CHR0007185) | |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2024-10-18 |