| NPI | 1942530399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 375615-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3985) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2021-03-15 |