| NPI | 1073859625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0006836) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC-1269) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2014-04-28 |