| NPI | 1497994503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 10651) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: LA 1696) |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2025-12-18 |