| NPI | 1245770767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007578) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11892) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2019-09-03 |