| NPI | 1215922141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0006980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3617012) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-04-23 |