| NPI | 1306349527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0007783) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CO 0007783) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2022-09-09 |