| NPI | 1487343901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 13368721-1202) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: UT 13368721-1202) |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-01 |