| NPI | 1114757762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16177) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: TX 16177) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-09-05 |