| NPI | 1306515192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15539) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3478) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2023-03-08 |