| NPI | 1730663634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2004) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13900) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2025-09-18 |