| NPI | 1952580607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2188) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch 9432) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2018-05-22 |