| NPI | 1699127159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13577) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1725) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2019-07-19 |