| NPI | 1730165606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 2725621202) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: UT 2725621202) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2023-06-29 |