| NPI | 1699795187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12361) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28234) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2020-11-03 |