| NPI | 1952288672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 183977) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TX 183977) |
| 111N00000X Chiropractor (Licence: TX 183977) | |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-18 |