| NPI | 1841835055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14221) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX TX14221) |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2020-05-29 |