| NPI | 1871620187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 8304) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TX 1193) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-11-04 |