| NPI | 1467420513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA0003980) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 1281) |
| 175F00000X Naturopath (Licence: AZ 07-988) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-07-28 |