| NPI | 1003902560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-5940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9139) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-08-08 |