| NPI | 1184962938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007194) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 2804381202) |
| 111N00000X Chiropractor (Licence: NC 4349) | |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2014-12-25 |