| NPI | 1801044177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13274) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4438-012) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2017-02-01 |