| NPI | 1992935720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 1909) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11204) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2014-07-10 |