| NPI | 1225115587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 1457) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: CO 1457) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-02-09 |