| NPI | 1871378588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 12275004-1202) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: UT 12275004-1202) |
| 111NR0400X Chiropractor Rehabilitation (Licence: UT 12275004-1202) | |
| 111NS0005X Chiropractor Sports Physician (Licence: UT 12275004-1202) | |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-08-30 |