| NPI | 1174357677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 08087) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC00449) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2024-08-27 |