| NPI | 1952511503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1526) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NM 1526) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-09 |