| NPI | 1851716658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13067) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC1270) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2017-02-01 |