| NPI | 1598915241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2107) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14070) |
| 111N00000X Chiropractor (Licence: UT 71183171202) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2022-07-21 |