| NPI | 1689755845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2224) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273120) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-09-29 |