| NPI | 1285314567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13437) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2023-07-20 |