| NPI | 1720218548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2221) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NM DC2221) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2024-06-04 |