| NPI | 1861784431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15255) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5654) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2024-04-23 |