| NPI | 1013957596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28048) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2020-03-19 |