| NPI | 1831632215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14014) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MO 2015016402) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2022-04-04 |