| NPI | 1659824795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC23007) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NM 510640195) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2023-08-23 |