| NPI | 1780334870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16117) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT132580) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2024-07-12 |