| NPI | 1962739227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NM DC2113) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6241) |
| 111NN0400X Chiropractor, Neurology (Licence: CO 6241) | |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: CO 6241) | |
| 111NR0400X (Licence: CO 6241) | |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2020-07-22 |