| NPI | 1265071641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008144) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X01332501) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2022-07-14 |