| NPI | 1578009874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14748) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: TX 118040) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2021-05-24 |