| NPI | 1710720636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 12972586-1202) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: UT 12972586-1202) |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: UT 12972586-1202) | |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-06-18 |