| NPI | 1972153641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14403) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003083A) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2020-10-02 |