| NPI | 1942509641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 11760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 10274) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-11-11 |