| NPI | 1194200725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2024-0014) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 16201) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 18-381) | |
| Enumeration Date | 2018-09-29 |
| Last Update Date | 2024-11-27 |