| NPI | 1205081726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5358) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-31895) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2015-07-02 |