| NPI | 1104122530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6811) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO chr-6811) |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2013-06-28 |