| NPI | 1528154630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2183) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 10402693) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2019-10-30 |