| NPI | 1033356225 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6812) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 111N00000X Chiropractor (Licence: PR 487) | |
| Enumeration Date | 2009-01-10 |
| Last Update Date | 2013-10-24 |