| NPI | 1215410212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: UT 10976165-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 10976165-1202) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2025-10-29 |