| NPI | 1164573085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 853) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: TX 4937) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2020-08-11 |