| NPI | 1770753592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10093) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 9082) |
| 111N00000X Chiropractor (Licence: CA 29845) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2019-05-14 |