| NPI | 1467541276 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6044) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2006029873) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2012-02-21 |