| NPI | 1922617075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 14456) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14456) |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2024-06-19 |