| NPI | 1356093686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2179) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0008421) |
| 111N00000X Chiropractor (Licence: CO CHR.0008421) | |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2025-02-06 |