| NPI | 1245221431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6601) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25280) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2014-06-04 |