| NPI | 1992817654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12622) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4391) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-04-17 |