| NPI | 1962756379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8759) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11348) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2023-11-29 |