| NPI | 1841929403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16686) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 2000051069) |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-10-27 |