| NPI | 1538525530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16595) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC02238) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2026-05-26 |