| NPI | 1730969304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 13390110-1202) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 16472) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2026-01-15 |