| NPI | 1629118252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30471) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2022-10-10 |