| NPI | 1093843302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 27-3072) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20436) |
| 111N00000X Chiropractor (Licence: CO 4556) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2007-09-28 |