| NPI | 1487040291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008055) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 077525) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-10-18 |