| NPI | 1982629150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM dc2203) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC21162) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-08-24 |