| NPI | 1598075707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1872) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011655) |
| 111N00000X Chiropractor (Licence: TX 11938) | |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2019-08-28 |