| NPI | 1164009775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5615) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2024-09-18 |