| NPI | 1255894721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34519) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2023-07-20 |