| NPI | 1730612607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2179) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13420) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2019-08-22 |