| NPI | 1679675870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8118) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4925) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2022-09-15 |