| NPI | 1336236199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3343) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2022-10-19 |