| NPI | 1205827953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1497) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14839) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2022-04-09 |