| NPI | 1700930971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5416) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 814) |
| 111N00000X Chiropractor (Licence: AR 1146) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2017-02-06 |