| NPI | 1861298754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14905) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: TX 14905) |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 14905) | |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-03-03 |