| NPI | 1548606601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 15645) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7875588-1202) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-08-03 |