| NPI | 1255368718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1691) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 0104408) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-01-18 |