| NPI | 1841420411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3484) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2020-11-17 |