| NPI | 1922871540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1629) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 15891) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-11-01 |