| NPI | 1093917973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0003773) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3773) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2022-07-15 |