| NPI | 1831131374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13665) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA dc008839) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2018-03-17 |