| NPI | 1184245573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 5981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1206) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2020-04-27 |