| NPI | 1306840798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008688) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: CO EL.2787472) |
| 111N00000X Chiropractor (Licence: TX 11871) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2023-07-28 |