| NPI | 1912138348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 14409) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05275) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2023-02-03 |