| NPI | 1932642576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13331) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5775) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2021-04-01 |