| NPI | 1578270211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1368) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 15322) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2023-01-29 |