| NPI | 1215468384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008571) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 1057) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-08-07 |