| NPI | 1023289899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6876966-1202) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 6876966-6009) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2026-04-17 |