| NPI | 1689814311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13243) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30541) |
| 111N00000X Chiropractor (Licence: SC 3558) | |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2016-07-28 |