| NPI | 1245279363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007353) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 007551) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-06-21 |