| NPI | 1366894255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13329) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NM 2143) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-03-28 |