| NPI | 1235863226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16946) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14087) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2026-08-20 |