| NPI | 1346835881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 12167990-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 121679901202) |
| 111N00000X Chiropractor (Licence: TX 14919) | |
| Enumeration Date | 2021-03-06 |
| Last Update Date | 2024-02-08 |