| NPI | 1417710914 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 2029) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 15921) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-02-06 |