| NPI | 1568762441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2158) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11626) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2022-09-28 |