| NPI | 1326687955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC DC.4814) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008128) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2022-12-13 |