| NPI | 1730431396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1680) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12178) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2015-04-29 |