| NPI | 1871889766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12823) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011576) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-03-08 |