| NPI | 1316239577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6602) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007275) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2013-03-19 |