| NPI | 1871500074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13862) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 21938) |
| 111N00000X Chiropractor (Licence: GA CHIR007758) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-08-23 |