| NPI | 1891967873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11382) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556601) |
| 111N00000X Chiropractor (Licence: UT 69976151202) | |
| Enumeration Date | 2008-03-30 |
| Last Update Date | 2013-07-12 |