| NPI | 1912436825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16167) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13476) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2019-12-12 |