| NPI | 1558375436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2069) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7709) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2021-04-06 |