| NPI | 1073805115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6680) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1741) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2013-07-30 |