| NPI | 1720152127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 4869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001326A) |
| 111N00000X Chiropractor (Licence: CA DC 18548) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2012-03-02 |