| NPI | 1932449295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13595) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4312) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2021-12-13 |