| NPI | 1639666357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14069) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1833) |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2021-11-11 |