| NPI | 1114495637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 1077) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007919) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2022-10-19 |