| NPI | 1932106788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 373666-1202) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: UT 373666-1202) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2025-06-16 |