| NPI | 1366719163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO DR.0067225) |
| 111N00000X Chiropractor (Licence: NY X009427) | |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2026-04-15 |