| NPI | 1629003884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10965) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC1021) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2024-02-06 |