| NPI | 1053787408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other (Licence: TX 93080) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12610) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2025-12-03 |