| NPI | 1053771881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.012804) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2018-05-29 |