| NPI | 1083746614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4592) |
| Additional Taxonomies | 111NR0400X (Licence: CO 4592) |
| 171100000X Acupuncturist (Licence: CO 4592) | |
| 225700000X Massage Therapist (Licence: CO 4592) | |
| 225000000X Orthotic Fitter (Licence: CO 4592) | |
| 225100000X Physical Therapist (Licence: CO 4592) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2010-04-21 |