| NPI | 1811521065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14476) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4535) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2024-10-16 |