| NPI | 1578895561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 11743) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: AR 15705) |
| Enumeration Date | 2010-02-02 |
| Last Update Date | 2023-10-12 |