| NPI | 1245398171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR6707) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007961) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-07-21 |