| NPI | 1013570704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14015) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-04-27 |