| NPI | 1649385980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1186) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 5885) |
| 111N00000X Chiropractor (Licence: UT 2943171202) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2017-02-08 |