| NPI | 1497065825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11584) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2011-11-29 |