| NPI | 1932089646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 15631) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 16845) |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2026-08-06 |