| NPI | 1003206095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO chr0007891) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5614) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2023-04-25 |