| NPI | 1144610148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9304) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007255) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2025-05-19 |