| NPI | 1245945534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15007) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 15007) |
| 111NR0200X Chiropractor, Radiology (Licence: TX 15007) | |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-01-20 |