| NPI | 1497464176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14858) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008611) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2026-06-26 |