| NPI | 1225693955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0008705) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 5602) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 6233) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2024-01-24 |