| NPI | 1861705360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11513) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2016-03-16 |