| NPI | 1689805038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7225838-1202) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: UT 7225838-1202) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: UT 7225838-1202) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: UT 7225838-1202) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: UT 7225838-1202) | |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2009-08-03 |