| NPI | 1841369238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: TX 8558) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5260) |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 8558) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-03-20 |