| NPI | 1508484064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008267) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO T-CHR.0000004) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2022-12-23 |