| NPI | 1205154713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6523) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008716) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2023-02-21 |