| NPI | 1083176390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1992) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 16426) |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2025-10-14 |