| NPI | 1144540923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1816) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6524) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2010-06-03 |