| NPI | 1518026012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7693068-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4723) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-03-07 |