| NPI | 1194741843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0005699) |
| Additional Taxonomies | 111NR0400X (Licence: CO EL.2782841) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0005699) | |
| 171100000X Acupuncturist (Licence: CO AC.2786126) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-12-20 |