| NPI | 1275856528 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6471) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6471) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2013-01-03 |