| NPI | 1346609104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007372) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO EL.2786470) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |