| NPI | 1023602406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15543) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9039) |
| Enumeration Date | 2021-02-25 |
| Last Update Date | 2023-03-15 |