| NPI | 1497229967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008433) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12650) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2023-04-05 |