| NPI | 1942505995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12511) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: KY 5271) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2019-06-28 |