| NPI | 1033564224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007426) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009589) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2018-01-03 |