| NPI | 1831101021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: NM 1057) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM CNP-02134) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-04-08 |