| NPI | 1831602580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM DC2271) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2021-09-01 |