| NPI | 1417001868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: CO CO4130) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA CO4130) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |