| NPI | 1184420937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1402) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 15428) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |