| NPI | 1689808982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1548) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2022-08-03 |