| NPI | 1144356486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor Internist (Licence: NM 1126) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1126) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2019-01-30 |