| NPI | 1639785173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 123902991202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14500) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2023-08-02 |