| NPI | 1770882508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11719) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1586) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2026-09-03 |