| NPI | 1811655996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor Neurology (Licence: TX 09305) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: TX 09305) |
| 111NR0400X Chiropractor Rehabilitation (Licence: TX 09305) | |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2021-12-06 |