| NPI | 1124508858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14155) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 6042880-1202) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2020-04-16 |