| NPI | 1992242499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05829) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2018-09-27 |