| NPI | 1134426760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 726) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6645) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2017-08-29 |