| NPI | 1043827819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14515) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: 14515) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-10-30 |