| NPI | 1093346082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2109) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008158) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2022-05-04 |