| NPI | 1265629505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 3929) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CO 3929) |
| 225700000X Massage Therapist (Licence: CO 3929) | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2007-10-01 |