| NPI | 1487763132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 464) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2516) |
| 111N00000X Chiropractor (Licence: AZ 3304) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-05-12 |