| NPI | 1376065078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007293) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO CHR.0007293) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: CO CHR.0007293) | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2022-07-21 |