| NPI | 1093720864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NM 1375) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1375) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2025-10-16 |