| NPI | 1659626869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13793) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007553) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2021-07-21 |