| NPI | 1982705240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10937) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC01614) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-02-17 |