| NPI | 1831461995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6787) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11956) |
| 111N00000X Chiropractor (Licence: NM 2110) | |
| 111N00000X Chiropractor (Licence: IN 08002943A) | |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2020-10-20 |