| NPI | 1972876845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1645) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11914) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2019-04-18 |