| NPI | 1437412574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1955) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1042) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2012-06-22 |