| NPI | 1750531182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11113) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3887) |
| Enumeration Date | 2008-09-22 |
| Last Update Date | 2023-02-15 |