| NPI | 1386154888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2259) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5851) |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2023-10-16 |