| NPI | 1932625092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 13573) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: TX 13573) |
| 111NR0400X (Licence: TX 13573) | |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2018-04-16 |