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Individual
MR. GRANT EVANS WEIDLER
Active
Individual
MR. GRANT EVANS WEIDLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC.
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC01119
TEXAS MEDICAL BOARD/TEXAS BOARD OF ACUPUNCTURE EXAMINERS
TX
Enumeration date
04/10/2009
Last updated
01/10/2022
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