| NPI | 1043362817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4782) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-09 |