| NPI | 1427209774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6193) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008341) |
| 111N00000X Chiropractor (Licence: PA DC010328) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2018-04-05 |