| NPI | 1770203903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16098) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 198331) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-07-22 |