| NPI | 1316475767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0007618) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CO 2786668) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2020-02-05 |