| NPI | 1730571860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 606) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 120508) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2018-05-24 |