| NPI | 1245629047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: CO CHR.0007240) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007240) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2022-07-21 |