| NPI | 1851414700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11467) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6217) |
| 111N00000X Chiropractor (Licence: MN 4543) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2022-07-21 |