| NPI | 1417481342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13966) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2022040813) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2025-06-19 |